Restricción de crecimiento fetal, epigenética y transmisión trans generacional de las enfermedades crónicas y la pobreza

El conjunto de las enfermedades crónicas denominadas tradicionalmente como “no transmisibles” (síndrome metabólico,diabetes, obesidad, hipertensión, resistencia a la insulina, entre otras) podrían originarse tempranamente en la vida fetal y en la primera infancia por medio de la activación de mecanismos epigenéticos, aun no suficientemente conocidos pero que claramente no implicarían cambios estructurales en las secuencias génicas. El presente artículo, intenta poner a punto el conocimiento disponible desde una perspectiva perinatal. Además, se propone una hipótesis por la cual existiría la posibilidad de la transmisión trans generacional de las enfermedades crónicas en el contexto de la pobreza y la exclusión social. La activación epigenética del denominado “genotipo ahorrador”, se encuentra de manera más prevalente en los sectores socio económicos, más vulnerables y vulnerados y tienden a aumentar el riesgo en su progenie. Se propone que estas enfermedades crónicas son en realidad socialmente transmisibles y se evalúa cómo este conocimiento cambiará el manejo clínico de la restricción de crecimiento intrauterino. Por último; se analizan las ventanas de oportunidad que las políticas públicas tienen para revertir este círculo vicioso. (Horiz Med 2013; 13(4): 45-53

Overall and abortion‐related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women's rights

To evaluate changes in maternal mortality rates in Uruguay over the past 25 years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators. Data on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter‐Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five‐year period, the variation in the percentage of abortion‐related deaths, and the correlation with HDI indicators were evaluated. Maternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10 years also coincides with a reduction in poverty and an improvement in the HDI. A rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion.1341S20S2

National trends in obesity in pregnant women from Uruguay, 2012–2019: A population-based cross-sectional study

There is a sustained annual increase of overweight and obesity in pregnant women in Uruguay with almost 45% incidence of overweight or obesity in 2019.Fil: Cormick, Gabriela. Universidad Nacional de La Matanza; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Tomasso, Giselle. Universidad de la República; UruguayFil: Aleman, Alicia. Unidad de Investigación Clínica y Epidemiológica Montevideo; UruguayFil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Overall and abortion-related maternal mortality rates in Uruguay over the past 25years and their association with policies and actions aimed at protecting women’s rights

AbstractObjectiveTo evaluate changes in maternal mortality rates in Uruguay over the past 25years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators.MethodsData on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter-Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five-year period, the variation in the percentage of abortion-related deaths, and the correlation with HDI indicators were evaluated.ResultsMaternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10years also coincides with a reduction in poverty and an improvement in the HDI.ConclusionA rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion

Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

Abstract Antenatal care reduces maternal and perinatal mortality and morbidity through the detection and treatment of some conditions, but its coverage is less than optimal within certain populations. Supply kits for maternal health were designed to overcome barriers present when providing care during pregnancy and childbirth particularly to women from underserved population. We conducted a mixed-methods systematic review on the use of supply kits. This manuscript presents the findings from qualitative studies that reported barriers, facilitators, and user’s recommendation in the adoption and implementation of any type of kit designed to be used during pregnancy or childbirth. This review included eight studies, and seven were implemented in developing countries. Most studies assessed the implementation of clean delivery kits to be used during labour and delivery, and contributed to gain insights into factors that may hinder or foster the use of kits. Clean delivery kits were conceived to cope with barriers related mainly to access. The most important barrier identified were those related to the socio-cultural and the lack of knowledge dimension such as who held the decision-making authority in the household, as well as popular beliefs behind the idea that birth preparation could bring bad luck, may prevent clients from adhering to their use. In addition, financial constraints and limited understanding of the instructions of use were accessibility barriers found. On the other hand, once used, clean delivery kits for maternal health were accepted by women and health workers. Convenience, hygienic components, and avoidance of delays in receiving care were viewed as satisfactory features. Supply kits are mostly affordable and easily deployable. Increasing awareness among the population about the offered kits and providing information on their benefits emerges as a critical step to foster use in settings where kits are available. Implementation of this strategy requires low complexity resources and could make the use of kits an accepted alternative to increase the use of evidence-based interventions and thus improve quality of care during pregnancy, childbirth and neonatal period mainly at the community level in low income countries and remote areas with low access

Supply kits for antenatal and childbirth care: a systematic review

Abstract Introduction It is critical to increase the uptake of interventions proven to be effective to improve maternal and perinatal outcomes. Supply kits have been suggested to be a feasible strategy designed to ensure timely availability and effective follow-up of care. Objective We conducted a systematic review to summarize the evidence on the uptake, effectiveness and safety of supply kits for maternal care. Search strategy MEDLINE, the Cochrane Pregnancy and Childbirth Group’s Trials Register, Campbell Collaboration, Lilacs, Embase and unpublished studies were searched. Selection criteria Studies that reported the efficacy, safety and use of supply kits for maternal healthcare were eligible. Participants were pregnant women or in childbirth. Supply kits were defined as a collection of medicines, supplies or instruments packaged together with the aim of conducting a healthcare task. Data collection and analysis Two reviewers independently performed the screening, data extraction, and methodological and quality assessment. Main results 24 studies were included: 4 of them were systematic reviews and 20 primary studies. Eighteen studies evaluated a so-called “clean delivery kit”. In all but two studies, the kits were used by more than half of the participants. A meta-analysis was deemed inappropriate due to the heterogeneity in study design, in the components of the interventions implemented, in the content of the kits, and in outcomes. Nine studies assessed neonatal outcomes and found statistically significant reductions in cord infection, sepsis and tetanus-related mortality in the intervention group. Three studies showed evidence of reduced neonatal mortality (OR 0.52, 0.60 and 0.71) with statistically significant confidence intervals in all cases. Four studies reported odd ratios for maternal mortality, but only one showed evidence of a statistically significant decrease in this outcome but it was ascribed to hand washing prior to childbirth and not with the use of kits. Conclusion This review suggests potential benefits in the use of supply kits to improve maternal and neonatal health. However, the observational nature of the studies, the heterogeneity and the use of kits incorporated within complex interventions limit the interpretation of the findings

Additional file 1: of Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

Annex I Search Strategy. (DOCX 15 kb

Additional file 2: of Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

Annex II Components of the kits. (DOCX 18 kb

Additional file 3: of Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

Annex III Quality assessment by individual study and summary of methodological quality assessment of risk of bias. (DOCX 94 kb